. 2022 Jul;105(7):2611-2616.

doi: 10.1016/j.pec.2022.03.011. Epub 2022 Mar 14.

Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Rita Mangione-Smith¹, Jeffrey D Robinson², Chuan Zhou³, James W Stout⁴, Alexander G Fiks⁵, Madeleine Shalowitz⁶, Jeffrey S Gerber⁷, Dennis Burges⁸, Benjamin Hedrick⁹, Louise Warren¹⁰, Robert W Grundmeier¹¹, Matthew P Kronman¹², Laura P Shone¹³, Jennifer Steffes¹⁴, Margaret Wright¹⁵, John Heritage¹⁶

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. Electronic address: Rita.M.Mangione-Smith@kp.org.
² Department of Communication, Portland State University, Portland, OR, USA. Electronic address: jeffreyr@pdx.edu.
³ Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: Chuan.Zhou@seattlechildrens.org.
⁴ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: jstout@u.washington.edu.
⁵ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: fiks@email.chop.edu.
⁶ Department of Psychiatry and Behavioral Medicine, Rush University School of Medicine, Chicago, IL, USA. Electronic address: Madeleine_Shalowitz@rush.edu.
⁷ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: GERBERJ@email.chop.edu.
⁸ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: dburges@uw.edu.
⁹ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: bhedrick@uw.edu.
¹⁰ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: lcnovak@uw.edu.
¹¹ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: grundmeier@email.chop.edu.
¹² Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: matthew.kronman@seattlechildrens.org.
¹³ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: lshone@aap.org.
¹⁴ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: jsteffes@aap.org.
¹⁵ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: mewright@uic.edu.
¹⁶ Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: heritage@ucla.edu.

PMID: 35341612
PMCID: PMC9203931
DOI: 10.1016/j.pec.2022.03.011

Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Rita Mangione-Smith et al. Patient Educ Couns. 2022 Jul.

. 2022 Jul;105(7):2611-2616.

doi: 10.1016/j.pec.2022.03.011. Epub 2022 Mar 14.

Authors

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. Electronic address: Rita.M.Mangione-Smith@kp.org.
² Department of Communication, Portland State University, Portland, OR, USA. Electronic address: jeffreyr@pdx.edu.
³ Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: Chuan.Zhou@seattlechildrens.org.
⁴ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: jstout@u.washington.edu.
⁵ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: fiks@email.chop.edu.
⁶ Department of Psychiatry and Behavioral Medicine, Rush University School of Medicine, Chicago, IL, USA. Electronic address: Madeleine_Shalowitz@rush.edu.
⁷ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: GERBERJ@email.chop.edu.
⁸ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: dburges@uw.edu.
⁹ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: bhedrick@uw.edu.
¹⁰ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: lcnovak@uw.edu.
¹¹ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: grundmeier@email.chop.edu.
¹² Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: matthew.kronman@seattlechildrens.org.
¹³ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: lshone@aap.org.
¹⁴ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: jsteffes@aap.org.
¹⁵ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: mewright@uic.edu.
¹⁶ Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: heritage@ucla.edu.

PMID: 35341612
PMCID: PMC9203931
DOI: 10.1016/j.pec.2022.03.011

Abstract

Objective: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes.

Methods: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules.

Results: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005).

Conclusions: Our findings support the receipt fidelity of the intervention's communication training content.

Practical implications: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.

Trial registration: ClinicalTrials.gov NCT02943551.

Keywords: Acute respiratory illness; Antibiotic prescribing; Clinician-parent communication; Pediatrics.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

**Figure 1.**
Study intervention and timing

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References

1. Butler CC, Simpson SA, Dunstan F, Rollnick S, Cohen D, Gillespie D, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ 2012;344:d8173. - PMC - PubMed
1. Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013;382:1175–82. - PMC - PubMed
1. Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, et al. Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial. Ann Fam Med 2019;17:125–32. - PMC - PubMed
1. Gulliford MC, Juszczyk D, Prevost AT, Soames J, McDermott L, Sultana K, et al. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Health technology assessment (Winchester, England) 2019;23:1–70. - PMC - PubMed
1. Mortazhejri S, Hong PJ, Yu AM, Hong BY, Stacey D, Bhatia RS, et al. Systematic review of patient-oriented interventions to reduce unnecessary use of antibiotics for upper respiratory tract infections. Syst Rev 2020;9:106. - PMC - PubMed

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Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Affiliations

Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical